There are drugs that are seriously and correctly contraindicated during pregnancy.
Thalidomide is one example.
However, “Contraindicated in women who may become pregnant,” and “Contraindicated in women of childbearing age,” are totally different things.
I was horrified, therefore, to come across government and medical information stating that Valproate medications must not be used in women of childbearing age without compelling reason, and that women must be placed on a pregnancy prevention programme involving the use of reliable contraception – meaning implants, certain types of IUD, contraceptive injections, or sterilisation.
A woman has the right to choose not to have sex. That it should still be necessary to state this is outrageous.
The corollary to this is that women who choose not to have sex should be entiled to expect to be given the most appropriate treatment for an illness regardless of its contraindication in pregnancy.
They should also not be expected to damage their health with drugs and devices intended to “medicate” the body against its natural functioning, with a high risk of causing pain and/or other side effects, in order to spare an imaginary and impossible child damage!
In practice, a certain amount of discretion is hinted at in the documents, and it may be that most doctors would in fact respond to the reality of their patient. My experience of the attitude with screening for sexually transmitted diseases does not in fact suggest the likelihood of this type of respect, and in any case, this does not solve the problem of the fact that the guidance prevents proper consideration of the most effective treatment in the first place.
That is, if a woman over childbearing age, or a man, presenting in the same way, would be prescribed a medication which is absolutely contraindicated in pregnancy, as the best to treat that illness, but a celibate woman of childbearing age would be offered something likely to be less effective or to have worse side effects merely because she was of childbearing age and therefore not to be given that medication unless there is no other option, a sort of prejudice is operating against these women. (A prejudice which applies, presumably, not merely to women who are celibate in the strict sense of the word, but also to sexually active lesbians).
Discretion also does not alter the way in which there is an underlying failure in the documents to acknowledge the women for whom the issue isn’t relevant, and in some ways this seems to me to be the most sinister. Is anyone who chooses not to have sex merely regarded as an unnatural, if not impossible, freak? Certainly this is the impression I have been left with, growing up with the modern casual attitude to sex and choosing instead the dignity of Christian chastity.
Disempowerment matters. To treat women as if they have no capacity to decide whether or not to have sex, and as if they have no responsiblity for the consequences of doing so, is to promugate, however unintentionally, one of the most hostile attitudes towards women: that of them existing merely to be sexually used.
The desire for respect for the disempowered where and as they currently are, is good. But it is necessary to be careful to make sure it is not being made worse, by the refusal to acknowledge the possibility of things becoming otherwise.
If the medical profession have duly warned us of the dangers to any child we might conceive, and have offered us the help our society thinks it is appropriate to offer not to conceive, it is totally our responsibility if we are not truthful with them.
I completely agree that a doctor who knows that a woman is sexually active should not give her high risk pregnancy drugs without being clear that she cannot conceive. That lies within the normal sphere of medical responsibility. Sex is designed and adapted to bring about conception: assuming that it will do so if the woman is biologically capable of pregnancy is perfectly appropriate!
I also totally agree that if patients are reporting a lack of adequate warning of the dangers of a particular medication in pregnancy, there is a need to alter the system. I have no objection to receiving pack after pack of medication covered 50% in pregnancy warnings and information about who to contact for help if there is any possibility of becoming pregnant. If irritating, the underlying message is one of care and assistance, and I have no issue with the fact that if in a minority, generic communications will involve a lot of things that are not relevant.
That is totally different from the possibility of the existence of a minority to which you belong being completely ignored, and therefore being denied appropriate responses.
I therefore have an objection to the fact that, “Consistently choose not to be sexually active,” is not automatically and clearly listed as a way of avoiding pregnancy in all such documents.
Women have the legal* right to choose how and under what circumstances we do or do not have sex.
It is an important consequence of that right that guidance for medical treatment should be responsive to a woman’s real choices, and not to an underlying prejudice that any woman of childbearing age is either sexually active or about to become so.
*”Legal,” and “moral” are not at all equivalents here. What constitutes the good use of freedom, and the appropriateness of the community not interfering with the bad use of it, are different things. I hold totally to the Christian view that sex is only right within conjugal marriage, but medical practice is rightly non-judgemental.